BRAIN TECH ACADEMY'S HIGH IMPACT LEARNING AND REMEMBERING PROGRAMME

4. REGISTRATION APPLICATION
BRAIN TECH ACADEMY: HIGH IMPACT LEARNING & REMEMBERING PROGRAMME
BRAIN TECH ACADEMY PLT 202-B-3, JALAN BURMA 10350 PENANG. braintechacademyplt@gmail.com
For enquiries please call : 012-2819331 (Pri) 017-8912331 (Vairavan)
017-8962331 (Ratna) 012-4921442 (Ravi)
APPLICANT INFORMATION
P A R TI C IP ANT’S NA ME:
DATE OF BIRTH: NRIC: PHONE:
CURRENT ADDRESS:
CITY: STATE: POSTAL CODE:
GENDER :MALE/FEMALE COUNTRY : EMAIL:
SCHOOL/COLLEGE/UNIVERSITY/OTHERS :
CONT A CT PER SON’ S DETAILS
NAME:
ADDRESS: RELATIONSHIP :
PHONE: EMAIL: FAX:
CITY: STATE: POSTAL CODE:
REGISTRATION FEES
RM1900.00 PER PAX (10% DISCOUNT OFFERED FOR SIBLINGS)
I ________________________________ NRIC __________________
HEREBY ENCLOSE :
CASH BY HAND FOR THE AMOUNT OF RM________________
CASH BANK IN FOR THE AMOUNT OF RM________________
CHEQUE NO __________________
NOTE : ALL PAYMENT MADE PAYABLE TO BRAIN ACADEMY PLT ARE NON
REFUNDABLE.
CASH & CHEQUE BANK INTO
BRAIN TECH ACADEMY PLT
CIMB BANK
ACCOUNT NO :
8007300713
TERMS & CONDITIONS
1. S U B STITUTE O F PA RTIC IPANT A LLOWED, P ROV IDED THE O RGANISER I S NOT IFIED I N WR ITING O F THE NAME O F T HE NEW
R E P LA CEMENT WI TH FULL D ETAI LS.
2. T R A NSF ER O F R EGISTRAT ION TO O THER P ROGRAMME IS NO T A LLOWED.
3. WE R E S ERVE T HE R IGHTS TO C ANCEL A ND/O R PO STPONE THE P ROGRAMME DUE TO UNFORSEEN C IRC UMSTA NCES.
PRIVACY & DISCLAIMER STATEMENT
YO U A RE R EC EIV ING THI S F LYER B ECA USE YO U HA VE A TTENDED OUR EVENTS O R PAR T O F O UR B USINESS CO NTA CTS DA TA
B A SE.THE O RGANISER R ESERV ES THE R IGHTS TO U SE T HE A BOV E I NFORMA TION TO PRO CESS YO UR R EGISTRA TION.THE
O RGA NISER WI LL NO T DISCLO SE YO UR I NFORMATION TO A NY T HIRD P A R TY UNLESS YO U HA VE CONSENTED TO S UCH
D I SC LO SURE O R WH ERE WE A RE R EQUIRED TO DO SO B Y LAW.THE INFORMA TION MA Y B E USED TO CO NTACT YO U FROM
T IM E TO T IME TO PROMOTE O R A NNOUNCE NEW P RO DUC TS A ND S ERV ICES O FF ERED B Y THE O RGANISER.
F O R MO RE I NFORMAT ION , PLEA SE VISI T ht tp://www.bra inte chaca demyma lay sia .com
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